Archived: Interserve Healthcare - Leeds

At our last inspection in March 2016 we identified three breaches of regulations. We found systems and processes were not operated effectively to report allegations of abuse in a timely way and systems were not in place to assess, monitor and improve the quality and safety of the service provided. We also found staff did not receive appropriate support through a robust programme of training.

At this inspection we found the provider had taken action and they were now meeting the requirements of these regulations. However, we recommended that quality assurance systems were reviewed to make sure they were strengthened. We saw there were processes in place to monitor and improve the service, however we found this had not always identified gaps on Medicines Administration Records (MARs). The manager had already begun to take action in response to this.

Overall, staff showed a good understanding of promoting choice and gaining consent from people. However, the registered manager and staff were not always acting in accordance with the requirements of the Mental Capacity Act 2005 and associated codes of practice.

The service is registered to provide personal care and/or treatment of disease, disorder or injury to people living in their own homes. Children and adults were supported. Three separate types of service were delivered; a service for people with complex health care needs, a home renal dialysis service and a service for people who required treatment through intravenous therapies.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The home intravenous therapies part of the service was managed by a central team and the manager of Interserve Healthcare- Leeds did not have day to day management oversight of this service. During the inspection we were told that the provider had identified a manager for the intravenous service and a separate application for their registration was to be made.

People who used the service told us they felt safe when using the service. Staff understood their responsibilities under safeguarding and we found safe recruitment procedures were in place. Overall medicines were managed safely and people told us they received good support with their medicines. We saw risks were well managed, and staff understood how to ensure these risks were minimised.

There were enough staff employed to provide support and ensure that people’s needs were met. Staff received appropriate supervision, appraisal and training to enable them to carry out their role. Staff spoke highly of the support and training the received.

People who used the service told us staff were well trained, caring and kind. Staff showed a good knowledge of the people they supported, and understood how to maintain people’s privacy and dignity. Staff described the care they delivered in a person centred way. It was clear they had developed positive relationships with people.

People were supported to maintain good health and staff had a good awareness of how to support people with nutrition and hydration.

Care plans were reviewed regularly, and we saw people were involved in this process. Staff received timely updates to ensure they were aware of any changes in people’s needs.

There were systems in place for responding to people’s concerns and complaints. People told us they knew how to raise concerns if they had any.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

Interserve provides care and support for people with complex health needs who live in their own homes. The service also provides care and support through a live-in service.

At the time of our inspection the service did not have a registered manager, although a manager had been recruited who had been in post for four weeks. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and relatives who used the service told us they felt safe with the staff who provided their care and support. Staff were able to identify signs of abuse and knew how to report their concerns. We found several examples of issues recorded as complaints which should have been reported to the Care Quality Commission and the local authority safeguarding team. We looked at recruitment practices which were found to be safely managed.

People told us there were occasions when their support did not arrive and we found the systems for managing rotas were not consistent for each person. People and relatives told us they were informed in the event staff were running late.

People told us they received their medicines on time, although we saw an example of one person’s medicine which had not been administered on several occasions without explanation. A programme of medication training for staff was underway.

The records we looked at showed some staff had completed training about the Mental Capacity Act (2005). Staff we spoke with demonstrated a satisfactory knowledge of the act and how it applied to their role. However, care plans we looked at did not always contain mental capacity assessments where required.

People were supported by staff to have adequate nutrition and hydration. We found the service worked with health professionals to ensure people received the support they needed to maintain good health.

We saw examples of a range of risk assessments in people’s care plans. We found care plans contained sufficient person-centred detail for staff to be able to provide care and support. People and relatives spoke positively about the care and support they received from staff who were familiar with their needs. Staff were aware of how to protect people’s privacy and dignity.

A programme of care plan reviews was being undertaken by the branch nurse as it had been identified during audits that these had lapsed.

People were familiar with the complaints process and knew who to contact if they were unhappy with their service. However, the record of complaints did not contain sufficient detail to evidence appropriate action had been taken and learning outcomes were not recorded.

The provider carried out its own audits of the service, but we found there was limited evidence of quality systems being used at a local level to ensure the service was effective. There was a positive culture in the organisation and people felt supported by the manager.

We found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.